-The 2010 conference was a landmark event. Before then, no meeting had ever been held that brought together representatives from all the trucking industry stakeholders (company executives, regulators, occupational medicine physicians, and truckers) with the professional sleep community (physicians, dentists, and service providers) for a day-long meeting.
-The goal was to promote a common understanding about sleep apnea and to provide information about the options available for diagnosis and treatment.
-The Sleep Apnea and Multi-modal Transportation Conference, (www.samtc2011.org), held in November expanded beyond trucking to include other modes of transportation: rail, aviation, marine, and transit.
Severe Asthma Remains Poorly Understood
-Up to 15 percent of people with asthma do not respond to standard inhaled corticosteroid therapy.
-Genetic factors may help to predict patients’ response to urgent therapies currently available.
-Halothane, sevoflurane, and isoflurane have been shown to facilitate positive pressure ventilation, while a small study of ketamine showed it increased partial pressure of oxygen and decreased partial pressure of carbon dioxide in arterial blood of patients in status asthmaticus who did not respond to conventional mechanical ventilation.
Treading a Fine Line
-The debate on how to mechanically ventilate patients with traumatic brain injury has largely focused on the dangers posed by CO2, a potent cerebral vasodilator.
-Twenty years ago, the goals of mechanical ventilation in TBI were to maintain good oxygenation and maintain mild hypocapnia to reduce cerebral hyperemia. Now, the thinking is toward strategies that limit ventilator-induced lung injury. These are conflicting paradigms.
-Most patients with brain injury do not have problems with ICP and should receive lung-protective mechanical ventilation.
-Don’t hyperventilate the patient. Mild hypercapnea is well tolerated and not a problem. Too much CO2 is less often a problem but low CO2 is a problem for almost everyone.
On the Cutting Edge
-Twenty years ago, the goals of mechanical ventilation in TBI were to maintain good oxygenation and maintain mild hypocapnia to reduce cerebral hyperemia. Now, the thinking is toward strategies that limit ventilator-induced lung injury. These are conflicting paradigms.
-Most patients with brain injury do not have problems with ICP and should receive lung-protective mechanical ventilation.
-Don’t hyperventilate the patient. Mild hypercapnea is well tolerated and not a problem. Too much CO2 is less often a problem but low CO2 is a problem for almost everyone.
On the Cutting Edge
-March 21 to 24, 2012, Fairmont Sonoma Mission Inn and Spa will open its doors to the 35th Annual Meeting and Educational Conference of NAMDRC (National Association for Medical Direction of Respiratory Care).
-“We’ve held the meeting in California’s wine region twice before, and they were our best attended meetings ever,” said Phillip Porte.
How to Choose a Sleep Center
- Check for a center’s accreditation.
-Check websites such as www.achc.org/accredited_organizations.php; www.sleepcenters.org; www.thecomplianceteam.org; and www.jointcommission.org/accreditation/ambulatory_sleep_centers.aspx.
-When calling centers, ask key questions:
Are you accredited and by whom? Is there a doctor consult before and after the sleep evaluation? Is the sleep physician board-certified and accredited? Are registered polysomnographic technologists on staff? Who will score my sleep study? How long will it take to get the results? Who will notify me of results and explain those results and any recommendations? If therapy is recommended, who will supply treatment, support, advice, and help in getting acclimated? May I have a full and complete copy of the sleep study and any prescription?
Top Issues for 2012
-Nearly everyone in the audience has been sending staff home because of low census. To compensate for revenue, hospital administrators are looking for ways to trim labor costs.
-Validating respiratory staffing levels can be difficult because about 85 percent of respiratory services do not have a current procedural terminology code.
-Respiratory therapists attend complicated labor and deliver y cases to give preemies’ their first breaths. They avert dislodged intubation tubes while transporting ventilator patients to radiology for computed tomography scans. Or they avoid full blown codes by participating on rapid response teams. Yet these important tasks can make the department appear less productive because fewer minutes are being spent on direct bill procedures
-Medicare plans to decrease reimbursement for the physician fee schedule by 27.4 percent Jan. 1.
-Looking for potential revenue sources outside of the department can help improve the department’s budget.
-Respiratory departments also should prepare for more careful inspection of the way care is delivered because hospitals are being pressured to determine the exact costs of providing services.
Shining a Light on Circadian Alignment
-About 20 percent of t he population is comprised of shift workers, and many experience shift work sleep disorder (SWSD).
-The disorder is characterized by insomnia, poor cognitive performance at night, and fatigue, as well as a higher risk for accidents, depression, stress, tobacco and alcohol addiction, hypertension, cancer, gastrointestinal problems, heart disease, obesity, sleep apnea, and more.
-Humans are diurnal animals who have evolved over millennia to live by circadian rhythms, which are driven mostly by daylight.
-While the U.S. Food and Drug Administration has approved modafinil, a wake-promoting agent, that can help shift workers stay alert, this pharmacological approach is not the primary treatment for SWSD.
-Light therapy has emerged as the most reliable means of dealing with circadian misalignment, simply because bright light is the most potent motivator of wakefulness
Patients Feel at Home With Spirometry
-Pulmonary function testing with spirometry is a standard component in the face-to-face evaluation and management of CF patients. FEV1 is easy to measure, is reproducible, and has been shown to be an excellent predictor of morbidity and mortality in CF.
-While it’s speculation, it may be that patients gained insight into t heir health through t he use of home spirometry and were able to take steps to maintain t heir health t hrough better medication adherence and better adherence with airway clearance techniques.
-“We’ve held the meeting in California’s wine region twice before, and they were our best attended meetings ever,” said Phillip Porte.
How to Choose a Sleep Center
- Check for a center’s accreditation.
-Check websites such as www.achc.org/accredited_organizations.php; www.sleepcenters.org; www.thecomplianceteam.org; and www.jointcommission.org/accreditation/ambulatory_sleep_centers.aspx.
-When calling centers, ask key questions:
Are you accredited and by whom? Is there a doctor consult before and after the sleep evaluation? Is the sleep physician board-certified and accredited? Are registered polysomnographic technologists on staff? Who will score my sleep study? How long will it take to get the results? Who will notify me of results and explain those results and any recommendations? If therapy is recommended, who will supply treatment, support, advice, and help in getting acclimated? May I have a full and complete copy of the sleep study and any prescription?
Top Issues for 2012
-Nearly everyone in the audience has been sending staff home because of low census. To compensate for revenue, hospital administrators are looking for ways to trim labor costs.
-Validating respiratory staffing levels can be difficult because about 85 percent of respiratory services do not have a current procedural terminology code.
-Respiratory therapists attend complicated labor and deliver y cases to give preemies’ their first breaths. They avert dislodged intubation tubes while transporting ventilator patients to radiology for computed tomography scans. Or they avoid full blown codes by participating on rapid response teams. Yet these important tasks can make the department appear less productive because fewer minutes are being spent on direct bill procedures
-Medicare plans to decrease reimbursement for the physician fee schedule by 27.4 percent Jan. 1.
-Looking for potential revenue sources outside of the department can help improve the department’s budget.
-Respiratory departments also should prepare for more careful inspection of the way care is delivered because hospitals are being pressured to determine the exact costs of providing services.
Shining a Light on Circadian Alignment
-About 20 percent of t he population is comprised of shift workers, and many experience shift work sleep disorder (SWSD).
-The disorder is characterized by insomnia, poor cognitive performance at night, and fatigue, as well as a higher risk for accidents, depression, stress, tobacco and alcohol addiction, hypertension, cancer, gastrointestinal problems, heart disease, obesity, sleep apnea, and more.
-Humans are diurnal animals who have evolved over millennia to live by circadian rhythms, which are driven mostly by daylight.
-While the U.S. Food and Drug Administration has approved modafinil, a wake-promoting agent, that can help shift workers stay alert, this pharmacological approach is not the primary treatment for SWSD.
-Light therapy has emerged as the most reliable means of dealing with circadian misalignment, simply because bright light is the most potent motivator of wakefulness
Patients Feel at Home With Spirometry
-Pulmonary function testing with spirometry is a standard component in the face-to-face evaluation and management of CF patients. FEV1 is easy to measure, is reproducible, and has been shown to be an excellent predictor of morbidity and mortality in CF.
-While it’s speculation, it may be that patients gained insight into t heir health through t he use of home spirometry and were able to take steps to maintain t heir health t hrough better medication adherence and better adherence with airway clearance techniques.
This post first appeared on Sometimes I Breathe: Respiratory Therapy, please read the originial post: here
